Nursing for Metformin-Associated Lactic Acidosis with Acute Kidney Injury: Case study

Abstract

The case study is a 65-year-old Thai woman with type 2 diabetes who received 2 tablets of metformin oral bid pc. The patient was transferred from the community hospital and admitted at King Narai hospital. Two days before she came to the hospital, she had vomiting 10 times a day and six mucus defecations. At the community hospital, she has a dyspnea breathing condition, then the doctor intubated the endotracheal tube and initially diagnosed with sepsis, acute kidney injury. The physician provided treatment with Ceftriaxone 2 gm v OD, 0.9% Nss 1,000 ml v 120 ml/hr and referred to King Narai hospital. At King Narai hospital, the patient had severe metabolic acidosis symptoms related to the wide anion gab 45.6, pH 7.013. The patient has confirmed the diagnosis with metformin associated lactic acidosis with acute kidney injury. After that, the doctor has an emergency hemodialysis treatment plan and cooperated with septic shock treatment. Because of the infection in the bloodstream, it is one of the causes that provoke the metformin associated lactic acidosis condition. Nurses provided critical care to treat severe metabolic acidosis by following CPG Sepsis, prepare the patient for Double Lumen Catheter (DLC) insertion and hemodialysis care. Nurses play a very important role to make a decision, use the nursing process; assessment, diagnosis, planning, implementation, and evaluation for critical care from severe lactic acidosis, acute renal failure. Also, nurses have to monitor the respiratory and hemodynamic changes in a timely critical phase. This case study was safe from crisis and was moved to the general ward, stop urgent dialysis, and discharge home for a total of 7 days of hospitalized admission.

The reason for studying this case is that a case study is complex, a rare but life-threatening health condition. Nurses to have the knowledge, expertise, experience, and ability to make good decisions, resulting in the outcome of the patient's health condition. this patient needs the prior-during-and post hemodialysis cares that reflect the nurses are well-versed in changing services and leading-edge technologies. Nursing care is comprehensive and reflective of the 4 dimensions of nursing, including promoting health, prevention, medical treatment, and rehabilitation. According to MALA is the leading cause or cause of death that is increasingly, and if the patient is not receiving immediate care, it can be fatal or require lifelong renal replacement therapy. It has a significant impact on patients and their families.